Endovascular prevention of distal embolism in pathogenesis of no-reflow phenomenon in percutaneous coronary interventions in patients with ST-segment elevation acute coronary syndrome

Sazanov G.V.; Shugushev Z.Kh.

doi:https://doi.org/10.17116/Cardiobulletin20241901123

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Abstract:

Pathogenesis of no/slow-reflow phenomenon following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome and ST-segment elevation (STEMI) requires constant and in-depth study. It is known that no-reflow phenomenon is complex and can be triggered by combination of the following factors: 1) distal embolism of infarct-related coronary artery; 2) myocardial ischemic damage in appropriate coronary basin; 3) myocardial reperfusion injury; 4) genetic predisposition to microvascular damage. The risk of no-reflow or slow-reflow phenomenon is present at any stage of PCI. Most often, no-reflow phenomenon occurs due to distal embolism following balloon inflation during pre-dilatation or stent implantation. Distal embolism of infarct-related coronary artery due to fragmentation and migration of atherothrombotic conglomerate during PCI is sufficiently studied. Endovascular prevention of slow/no-reflow phenomenon took place in different years of development of endovascular surgery, and some ones are used now. At various times, surgeons used mesh-covered stents, manual and rheolytic thrombaspiration, protection by filter traps, proximal protection from distal embolism by temporary occlusion of infarct-related coronary artery. However, manual thromboaspiration currently occupies its niche, and indications for this procedure are limited. Intravenous administration of platelet glycoprotein IIB/IIIA receptor inhibitors is the most effective and common pharmacological method for the treatment and prevention of no-reflow or slow-reflow phenomenon. Some authors suppose that direct stenting of infarct-related coronary artery without pre-dilatation reduces the risk of distal embolism. That is why this strategy may be preferable for revascularization in STEMI patients to reduce the risk of microvascular embolization.

Keywords:

no-reflow phenomenon

direct stenting

acute coronary syndrome with ST-segment elevation

percutaneous coronary intervention

Authors:

Sazanov G.V.

Stavropol Regional Clinical Hospital

ORCID: 0000-0003-0277-1880

Shugushev Z.Kh.

Peoples’ Friendship University of Russia

SPIN RSCI: 3390-4559
Scopus AuthorID: 6504325710
ORCID: 0000-0002-5335-5062

Received:

26.07.2023

Accepted:

28.08.2023

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References:

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